P - 78718REQUEST FOR ELECTRICAL INSPECTION
��� � � O 7 °� P Minnesota Board of"Electricity "�
� � �� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
` www.electricity.state.mn.us
Identity the work covered by this request: �, � rT ��
❑ NEW MODEL ❑ ADDITION ❑ REPAIR [:O W-en J v
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standarcl �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transtormers u to 10 KVA �$10
Above 800 Am re�$75 Transtormers over 10 KVA �$20
IRCUITS / FEEDERS Transfomier / Power Su for S' ns / Outline Li htin �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Indudes the Service ancllor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Tri Each Dwellin UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOITS Additional In ion Tri s�$20
Each S stem Devkz or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UN TOTAL FEE
3 m 12 Unas �$5o Per Una (minimum total fee is $20) ,.5�
Each AddiGonal Und � $25 �""�0T0fl "� °"'�`"
OTHER ADDITIONAL FEES
' U Retrofit � $25 r Fature
Cemer Pivot I' tion Boom �$40
Manufactured Home Park Lots �$25 I hereby certity that I inspected the elecVical installabon described herein on the detes stated:
Recreational Vehicle Park Sites �$5 � "01""" �� °"'�
Se rate 8ondin In ection �$20 r✓t� �°"3
S'al Ins ion �$30 r Hour FINAL INSPECiION �� w��
S ial In ection �$.31 er Mile �
THIS iNSTALLATION MAY BE ORDERED DISCONNECTE OT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? � Yes ❑ No Inspecdon OMier Than Rough-In: ❑ Ready Now Will Call
�'� �(� V� You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at: